This project focuses on southeast Kern county, where 74% of all deaths are related to chronic disease even though 91% of the population is under 65 years of age. Based on the findings of our planning grant activities, there are three critical issues that must be addressed in order improve quality and chronic disease management in this region, those being infrastructure, access, and education. The findings and issues of the planning grant efforts have led into three Key Aims, those being: Key Aim 1: Build infrastructure: Create a culture, organization and mechanisms that promote safe, high quality care Key Aim 2: Enhance the health professions workforce through education and organization Key Aim 3: Enhance quality care using HIT, focusing on diabetic care as a model. Multiple, comprehensive HIT strategies within these Key Aims will be implemented and evaluated, including 1) the development of a shared clinical data repository; 2) implementing a provider integration strategy which we have called an Integrated Technology Association ("ITA"); 3) implementing a telemedicine network that puts teleconsulatation and teleCME at the provider desktop with the more costly equipment at the hospital, and focusing on the health conditions that are problematic in the region:first on diabetes, second on women's health issues and dermatology, and third on heart disease; 4) development of a model chronic disease intervention addressing diabetes, that in year three will be translated into a broader model for the providers; 5) implemention of a web based personal health record for the diabetic population; 6) developing a unique HIT curriculum and training experience for health professionals; 7) designing and implementing a series of Ql studies and interventions built upon the data in the shared clinical data repository; 8) implementing a series of ehealth alerts for providers that include patient information, and 9) evaluating both the process and impact of all of these interventions.